Jong Man Kim1, Shin Hwang2, Kwang-Woong Lee3, Jae-Geun Lee4, Je Ho Ryu5, Bong-Wan Kim6, Dong Lak Choi7, Young Kyoung You8, Dong-Sik Kim9, Yang Won Nah10, Koo Jeong Kang11, Jai Young Cho12, Geun Hong13, In Seok Choi14, Hee Chul Yu15, Dongho Choi16, Myoung Soo Kim4. 1. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 2. Department of Surgery, Asan Medical Center, College of Medicine University of Ulsan, South Korea. 3. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. 4. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea. 5. Department of Surgery, Pusan National University College of Medicine, Busan, South Korea. 6. Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon, South Korea. 7. Department of Surgery, Catholic University of Daegu College of Medicine, Daegu, South Korea. 8. Department of Surgery, College of Medicine, Catholic University of Korea, Seoul, South Korea. 9. Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, South Korea. 10. Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. 11. Department of Surgery, Keimyung University School of Medicine, Daegu, South Korea. 12. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Sungnam, South Korea. 13. Department of Surgery, Ewha Woman's University School of Medicine, Seoul, South Korea. 14. Department of Surgery, Konyang University Hospital, Daejon, South Korea. 15. Department of Surgery, Chonbuk National University School of Medicine, Jeonju, South Korea. 16. Department of Surgery, Hanyang University College of Medicine, Seoul, South Korea.
Abstract
BACKGROUND: New-onset diabetes after transplantation (NODAT) is a serious complication following liver transplantation (LT). The present study aimed to investigate the incidence of and risk factors for NODAT using the Korean Organ Transplantation Registry (KOTRY) database. METHODS: Patients with history of pediatric transplantation (age ≤18 years), re-transplantation, multi-organ transplantation, or pre-existing diabetes mellitus were excluded. A total of 1,919 non-diabetic adult patients who underwent a primary LT between May 2014 and December 2017 were included. Risk factors were identified using Cox regression analysis. RESULTS: NODAT occurred in 19.7% (n=377) of adult liver transplant recipients. Multivariate analysis showed steroid use, increased age, and high body mass index (BMI) in recipients, and implantation of a left-side liver graft was closely associated with NODAT in adult LT. In living donor liver transplant (LDLT) patients (n=1,473), open donor hepatectomy in the living donors, steroid use, small for size liver graft (graft to recipient weight ratio ≤0.8), increased age, and high BMI in the recipient were predictive factors for NODAT. The use of antimetabolite and basiliximab induction reduced the incidence of NODAT in adult LT and in adult LDLT. CONCLUSIONS: Basiliximab induction, early steroid withdrawal, and antimetabolite therapy may prevent NODAT after adult LT. High BMI or advanced age in liver recipients, open donor hepatectomy in living donors, and small size liver graft can predict the occurrence of NODAT after adult LT or LDLT. 2020 Hepatobiliary Surgery and Nutrition. All rights reserved.
BACKGROUND: New-onset diabetes after transplantation (NODAT) is a serious complication following liver transplantation (LT). The present study aimed to investigate the incidence of and risk factors for NODAT using the Korean Organ Transplantation Registry (KOTRY) database. METHODS: Patients with history of pediatric transplantation (age ≤18 years), re-transplantation, multi-organ transplantation, or pre-existing diabetes mellitus were excluded. A total of 1,919 non-diabetic adult patients who underwent a primary LT between May 2014 and December 2017 were included. Risk factors were identified using Cox regression analysis. RESULTS: NODAT occurred in 19.7% (n=377) of adult liver transplant recipients. Multivariate analysis showed steroid use, increased age, and high body mass index (BMI) in recipients, and implantation of a left-side liver graft was closely associated with NODAT in adult LT. In living donor liver transplant (LDLT) patients (n=1,473), open donor hepatectomy in the living donors, steroid use, small for size liver graft (graft to recipient weight ratio ≤0.8), increased age, and high BMI in the recipient were predictive factors for NODAT. The use of antimetabolite and basiliximab induction reduced the incidence of NODAT in adult LT and in adult LDLT. CONCLUSIONS: Basiliximab induction, early steroid withdrawal, and antimetabolite therapy may prevent NODAT after adult LT. High BMI or advanced age in liver recipients, open donor hepatectomy in living donors, and small size liver graft can predict the occurrence of NODAT after adult LT or LDLT. 2020 Hepatobiliary Surgery and Nutrition. All rights reserved.
Entities:
Keywords:
Asia; Diabetes; immunosuppression; living donors
Authors: George Sgourakis; Arnold Radtke; Ioannis Fouzas; Sofia Mylona; Kostantinos Goumas; Ines Gockel; Hauke Lang; Constantine Karaliotas Journal: Transpl Int Date: 2009-05-13 Impact factor: 3.782
Authors: Deok-Gie Kim; Shin Hwang; Jong Man Kim; Je Ho Ryu; Young Kyoung You; Donglak Choi; Bong-Wan Kim; Dong-Sik Kim; Yang Won Nah; Tae-Seok Kim; Jai Young Cho; Geun Hong; Jae Do Yang; Jaryung Han; Suk-Won Suh; Kwan Woo Kim; Yun Kyung Jung; Ju Ik Moon; Jun Young Lee; Sung Hwa Kim; Jae Geun Lee; Myoung Soo Kim; Kwang-Woong Lee; Dong Jin Joo Journal: J Clin Med Date: 2022-07-20 Impact factor: 4.964